Engagement and Effectiveness of a Healthy Coping Intervention via Chatbot for university students: proof-of-concept study during the COVID-19 pandemic.

Abstract

BACKGROUND\nUniversity students are increasingly reporting common mental health problems, such as stress, anxiety and depression, and they frequently face barriers to seeking psychological support, because of stigma, cost and availability of mental health services. This issue is even more critical in the challenging time of COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy coping interventions by lowering cost and supporting prevention.\n\n\nOBJECTIVE\nTo conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, in a university students population.\n\n\nMETHODS\nIn a proof-of-concept study, 71 university students, 67.6% female (48/71), attending the first year of university during the Covid-19 pandemic, who were on average 20.6 years old (SD 2.4) were enrolled and asked to use the Atena psychoeducational chatbot for 4 weeks (8 sessions, 2 per week), providing healthy coping strategies based on Cognitive-Behavioral Therapy, positive psychology and mindfulness techniques. The intervention program consisted of conversations combined to audio-video clips delivered by the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the Perceived Stress Scale (PSS-10) and the Five Facet Mindfulness Questionnaire (FFMQ) at baseline and post intervention to assess effectiveness. They were asked to complete the User Engagement Scale (UES-short form) at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena post intervention.\n\n\nRESULTS\nParticipants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. 61 over 71 participants completed the first 2 weeks of intervention and provided data on engagement (14.1% attrition), while 41 participants completed the full intervention and the post intervention questionnaires (42.26% attrition). Results from the completers analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t (39) = 0.94, P = .009) and a decrease in stress symptoms (t (39) = 2.00, P = .05) for all participants post intervention. Participants improved significantly also in the Describing and NonJudging scales scores of FFMQ and asked for some improvements in the user experience with the chatbot.\n\n\nCONCLUSIONS\nThis study shows the benefit of deploying digital healthy coping interventions via chatbots to support university students with higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.\n\n\nCLINICALTRIAL